Warning

The information below is shown as a reference and it does not substitute the need for attendance for a course in first aid. Certification in First Aid knowledge cab be obtained only through attendance for such courses. See courses available.

The Primary Survey

Check for Danger

Are you or the casualty in any danger? If you have not already done so, make the situation safe and then assess the casualty.

Check the casualty’s Response

If the casualty appears unconscious check this by shouting

‘Can you hear me?’, ‘Open your eyes’
and gently shaking their shoulders.

If there is a response:
If there is no further danger, leave the casualty in the position found and summon help if needed.
Treat any condition found and monitor vital signs – level of response, pulse and breathing.
Continue monitoring the casualty either until help arrives or he recovers.

If there is no response:
Shout for help.
If possible, leave the casualty in the position found and open the airway.
If this is not possible, turn the casualty onto their back and open the airway.

Open the Airway

Open the airway by placing one hand on the casualty’s forehead and gently tilting the head back, then lift the chin using 2 fingers only.
This will move the casualty’s tongue away from the back of the mouth.

Check Breathing

Look, listen and feel for no more than 10 seconds to see if the casualty is breathing normally.
Look to see if the chest is rising and falling.
Listen for breathing.
Feel for breath against your cheek.

If the casualty is breathing normally, place them in the recovery position.
Check for other life-threatening conditions such as severe bleeding and treat as necessary.
If the casualty is not breathing normally or if you have any doubt whether breathing is normal begin CPR:

CPR for Adults

If you have someone with you, send them to Dial 112 for an ambulance immediately.
If you are alone Dial 112 for an ambulance immediately and then return to help the casualty.
CPR for Children (one year to puberty)
If you have someone with you, send them to Dial 112 for an ambulance immediately.
If you are on your own carry out CPR for 1 min before dialling 112 for an ambulance.
CPR for Babies (birth to one year)
If you have someone with you, send them to Dial 112 for an ambulance immediately.
If you are on your own carry out CPR for one min before dialling 112 for an ambulance.

Agonal breathing

This is common in the first few minutes after a sudden cardiac arrest. It usually takes the form of sudden irregular gasps for breath. It should not be mistaken for normal breathing and if it is present chest compressions and rescue breaths (together called cardio-pulmonary resuscitation or CPR) should be started without hesitation.

 

The Recovery position

An unconscious casualty who is still breathing is placed in the recovery position to protect the airway

CAUTION: A pregnant casualty should always be rolled to her left side in the recovery position in order to prevent the baby from obstructing blood flow back to the heart.

 

The secondary survey

You have to check for any symptoms which may not be seen during the primary survey by going through a ‘head-to-toe’ survey. Use the mnemonic AMPLE to make sure you covered all the aspects of the examination: 

A    –  Allergy           –     does the casualty have any allergies?

M   –  Medications   –     is the casualty on any medication?

P    –  Previous Medical History  – any history or warning medallion/bracelets, puffers/inhalers, insulin pen, auto-injectors?

L    –  Last Meal       –     when and what did the casualty last eat?

E    –  Event History –     How did the accident happen?

 

SHOCK

Disorders of the blood circulatory system

• Less blood available to circulate through the body and thus less oxygen is delivered to the brain.
• Normal amount of blood in the body is 6 litres (10 pints)

Causes

• Severe external/internal blood loss (more than 1.2 litres / 2pints).
• Loss of other body fluids: diarrhoea, vomiting, bowel obstructions and serious burns
• Heart unable to pump the blood: heart disease, heart attack or acute heart failure
• Overwhelming infection, low blood sugar (hypoglycaemia), hypothermia, severe allergic reaction (anaphylactic shock), drug overdose and spinal chord injury.

 

Recognition (Signs and Symptoms)

 Treatment                    

• Treat any possible cause of shock and reassure the casualty
• Lay casualty down on a rug or blanket – to slow down heartbeat
• Raise and support legs – to improve blood flow to the vital organs.
• Loosen tight clothing
• Keep casualty warm by covering his body and legs with coats or blankets
• Check and record level of breathing, circulation and response every 10 minutes.

 

DO NOT…..

• Do not allow the casualty to eat or drink as anesthetic may be needed. Just moisten the lips
• Do not leave the casualty unattended
• Do not allow casualty to smoke
• Do not use any hot water bottles
• If casualty is in later stages of pregnancy, help her to lie down leaning toward her left side to prevent baby restricting blood flow back to the heart.
• If casualty loses consciousness redo PRIMARY SURVEY.

EXTERNAL BLEEDING

Priorities of Bleeding

• Priority for minor bleeding: to prevent infection by cleaning and covering
• Priority for severe bleeding: to stop the bleeding

Treating Minor External Bleeding

• Use gloves
• Rinse wound under running water
• Pat dry with clean swab
• Cover wound with adhesive dressing
• If wound has a special risk of infection, advise the casualty to see a doctor.

 

Treating Severe External Bleeding     

• Use gloves.
• Apply direct pressure on wound with a dressing or a clean non-fluffy pad.
• Elevate wound above the level of the casualty’s heart to reduce blood flow to the wound
• Lay casualty down (slows down heart beat)
• Secure dressing with bandage to maintain pressure. It should not be too tight.
• If blood shows though the dressing apply a second one on top of the first. If blood shows again replace the dressing with a new one and re-apply pressure at the point of bleeding.
• Support the injured part in a raised position by a sling and/or bandage.
• Call 112.
• Check tightness of bandage, level of response, breathing and pulse every ten minutes.

• Do not allow the casualty to eat or drink as anaesthetic may be needed. Just moisten the lips
• If casualty loses consciousness redo PRIMARY SURVEY.

CHOKING

Definition       Mild Obstruction – Casualty finds it difficult to but is able to speak, cough, cry or breathe. No treatment is necessary.

Severe Obstruction – Casualty is unable to speak, cry, cough or breathe. Casualty will become unconscious with no assistance.

 

Treatment      ADULT & CHILD

Ask: “ Are you choking?

Give up to 5 back blows with the palm of your hand between the shoulder blades

if not successful, give up to 5 abdominal thrusts

If obstruction does not clear after 3 cycles of the above, call 112

Continue back blows and abdominal thrusts until help arrives

Medical attention IS A MUST if abdominal thrusts done.

 

HEAT EXHAUSTION

Causes           Caused by loss of salt and water from the body due to excessive sweating.

Usually happens gradually.

Support casualty’s head as he drinks water

Recognition  As condition develops there may be:

• Headache, dizziness and confusion
• Loss of appetite and nausea
• Sweating with pale clammy skin
• Cramps in arms, legs and abdominal wall
• Rapid, weaking pulse and breathing

 

Treatment      ·      Help Casualty to a cool place

• Lie down and elevate legs
• Give casualty plenty of water, oral rehydration salts or isotonic drinks will help salt replacement.
• Monitor and record vitals signs – level of response, pulse and breathing. CPR may be needed.
• Even if casualty recovers quickly, ensure that he/she is seen by a doctor.
• If the response deteriorates. Call 112 for an ambulance

HEAT STROKE

Caused by a failure of the “thermostat” in the brain, which regulates body temperature

• Body becomes dangerously overheated, usually to a high fever or prolonged exposure to heat.
• In some cases, heat stroke follows heat exhaustion when sweating stops and the body then

cannot be cooled by evaporation of sweat.

• Heat stroke can develop with little warning, causing unconsciousness within minutes of the

casualty feeling unwell.

Keep soaking the sheet

Recognition  There may be:

• Headache, dizziness and discomfort
• Restlessness and confusion
• Hot flushed and dry skin
• Rapid deteriorating level of response
• Full, bounding pulse
• Body temperature over 40°C (104°F)

Treatment      ·      Help casualty to a cool place. Remove as much of his outer clothing as possible. CALL 112.

• Wrap casualty in a cold, wet sheet and keep the sheet wet until his temperature

falls to 38°C (100.4°C) under the tongue, or 37.5°C (99.5°F) under the armpit. If sheet is not

available, fan the casualty or sponge him with cold water.

• Once casualty’s temperature appears to have returned to normal, replace wet sheet with dry one.
• Monitor and record vitals signs – level of response, pulse and breathing – until help arrives.
• If temperature rises again repeat the cooling process.

Anaphylactic Shock

Definition        A severe allergic reaction affecting the whole body. It may develop within seconds in susceptible individuals.

Chemicals are released into the blood that widen (dilate) blood vessels and constrict (narrow) air passages.

Blood pressure falls dramatically and breathing is impaired.

 

Causes           ·      Skin or airborne contact with particular materials

• The injection of a specific drug
• The sting of a certain insect
• The ingestion of food such as peanuts

 

Recognition    ·      Tongue and throat can swell – Risk of hypoxia since the amount of oxygen reaching vital organs is severely reduced.

• Anxiety.
• Widespread red, blotchy skin eruption
• Puffiness around the eyes
• Impaired breathing, ranging from a tight chest to severe difficulty
• Casualty may wheeze and gasp for air.
• Signs of shock

 

Treatment       ·      Urgent removal to hospital for emergency treatment with an injection of epinephrine (adrenaline)

• Check if casualty is carrying necessary medication (auto-injector of epinephrine) – help casualty use it.
• If casualty is conscious help him/her is position that relieves breathing difficulty – start with the half-sitting position
• If casualty becomes unconscious, perform a PRIMARY SURVEY and act accordingly. If breathing is present place in the RECOVERY POSITION.

 

Heart Conditions: Angina & Heart Attack.

Definition        ANGINA PECTORIS:                                                                      HEART ATTACK:

When coronary arteries which supply the heart muscle                 Most commonly caused by a sudden obstruction of the blood

with blood, become narrowed and cannot carry sufficient              supply to part of the heart muscle – for example because

blood to meet increased demands during exertion or                     of a clot in a coronary artery (coronary thrombosis).

excitement.                                                                                     Main risk is that heart will stop beating.

 

Recognition    ·      Vice-like central chest pain, spreading to jaw and                  ·      Persistent vie-like central chest pain, spreading to the

down one or both arms.                                                                  Jaw and down or both arms.

• Pain easing with rest ·      Pain does not ease with rest.
• Shortness of breath ·      Breathlessness and discomfort high in abdomen, which
• Weakness which is often sudden and extreme may feel similar to indigestion.
• Feeling of anxiety ·      Sudden faintness or dizziness.
• A sense of impending doom
• “Ashen” skin, and blueness at the lips
• A rapid, weak, or irregular pulse
• Profuse sweating
• Extreme gasping for air (“air hunger”

 

TREATMENT – Place casualty in a half-sitting position to ease strain on the heart.

Treatment       ANGINA PECTORIS

Help the casualty to sit down

Let casualty take medication (tablets or aerosol) or help to take.

Encourage casualty to rest. Attack should ease within minutes.

If the pain persists suspect a heart attack

If casualty has angina medication help him/her to take it.

 

Treatment       HEART ATTACK

Place casualty in comfortable position.

Half sitting position will ease strain on the heart.

Dial 112 and state that you suspect a heart attack.

If casualty asks you to call his doctor do so as well.

If casualty is conscious give 300mg aspirin to chew slowly.

Monitor & record vital signs – response, pulse and breathing.

 

Penetrated chest wound

Definition        When the chest is penetrated, damage to internal organs protected by the ribs may also get effected. The lungs are particularly susceptible to injury. It can either be itself perforated or if not, air can enter from the site of injury and exert pressure on the lung, and the lung may collapse – a condition which is called pneumothorax (A). The uninjured lung may also be affected by this.

The build-up of pressure may prevent the heart from refilling with blood properly, impairing the circulation and thus causing shock – a condition which is called tension pneumothorax

 

Recognition    ·      Difficult and painful breathing, possibly shallow, rapid and uneven.

• Signs and symptoms of hypoxia, including grey-blue skin (cyanosis)
• Coughed-up frothy red blood
• Blood bubbling out of the wound
• Sound of air being sucked into the chest as casualty breathes in
• Veins in the neck become prominent

Treatment       ·      Use his palm to cover the wound (A)

Encourage casualty to sit up and lean towards the injured side.

• Place a sterile dressing or non-fluffy clean pad over the wound. Cover with a plastic bag or foil. Secure firmly with adhesive tape on three edges (B),                                                                    or with bandages around the chest, so that dressing is taut.
• Dial 112.
• IF CASUALTY IS CONSCIOUS: Continue supporting casualty leaning towards injured side
• IF CASUALTY IS UNCONSCIOUS: Place in recovery position lying on the injured side.

 

 

Amputations

 

Aim                  To minimize shock and get casualty AND amputated part to hospital as soon as possible.

 

Treatment       ·      Control blood loss by direct pressure and elevation.

To casualty     ·      Apply a sterile dressing or non-fluffy clean pad and secure with a bandage.

• Call 112 & state that an amputation is involved.
• Monitor and record the vital signs – response, pulse and breathing.

 

Care of            ·      Wrap the severed part in kitchen film or a clean plastic bag.

Amputated      ·      Wrap the package in gauze or soft fabric.

Part                 ·      Place it in a contained full of crushed ice

• Mark container with name of casualty and time of injury.
• DO NOT wash the severed part
• DO NOT allow severed part to come into direct contact with ice.

 

Foreign object in the eye

 Definition        Can be a speck of dust, a loose eyelash, or even a contact lense that can float on the white of the eye.

 

Recognition    ·      Blurred vision

• Pain or discomfort
• Redness and watering of the eye
• Spasms in eyelids

Treatment       ·      Advise casualty to sit down facing the light; eye should not be rubbed

• Open eye of casualty and examine every part of the eye.
• If foreign object is identified, wash it our by pouring clean water from a glass on inner corner of the eye.
• If not successful, lift the object with a moist swab or a damp corner of a tissue.                                                                  Otherwise seek medical help.
• DO NOT REMOVE EMBEDDED OBJECT !! In this case just cover the eye and get casualty to hospital.
• IF OBJECT US UNDER UPPER EYELID: Ask casualty to grab lashes and pull the upper lid over the lower lid. Lower lashes may brush particle clear.

 

Absence seizures

Definition        A mild form of epilepsy, with small seizures during which the casualty appear distant and unaware of their surroundings

Recognition    ·      Sudden switching off; casualty may stare blankly ahead.

• Light or localized twitching or jerking of the lips, eyelids, head or limbs
• Odd “automatic” movements, such as lip-smacking, chewing or making noises.

Treatment       ·      Help casualty to sit down

• Make space around casualty & remove potentially dangerous items
• Talk to casualty and reassure – do not pester with questions.
• If casualty is not aware of any reason for seizure, advise to consult own doctor immediately.

Seizures in Adults

Definition        Also called a convulsion or fit. Consists of involuntary contractions of many muscles in the body, due to a disturbance in the electrical activity of the brain.

 

Causes           ·      Epilepsy

• Head injury
• Some brain-damaging diseases
• Shortage of oxygen or glucose in the brain
• Intake of certain poisons, including alcohol

 

Recognition    ·      The common sequence in an event of epilepsy are as follows:

• Casualty suddenly falls unconscious, often letting out a cry
• Casualty becomes rigid, arching his back
• Breathing may stop, lips may show a grey-blue tinge (cyanosis) and face and neck may become red and puffy
• Convulsive movements begin, jaw may be clenched and breathing may be noisy. Saliva may appear at the mouth and may be blood-stained if the lips or tongue have been bitten. There may be loss of bladder or bowel control.
• Muscles relax and breathing becomes normal; the casualty recovers consciousness, usually within a few minutes. May feel dazed or act strangely and may be unaware of his actions.
• After a seizure, the casualty may feel tired and fall into a deep sleep.

Treatment       ·      Ease the casualty while falling

• Make space around casualty & remove potentially dangerous items
• If possible protect the casualty’s head by placing soft padding underneath it.
• Loosen tight clothing around the neck
• When seizure stops, perform the PRIMARY SUREY and act accordingly.
• DO NOT move the casualty unless in immediate danger
• DO NOT put anything n the casualty’s mouth.
• DO NOT use force to restrain casualty.
• CALL 112 if

*          casualty is unconscious for more than 10 minutes

*          Seizure continues for more than 5 minutes

*          The casualty is having repeated seizure or having the first seizure

*          Casualty is not aware of any reason for the seizure.

 

Hypoglycaemia

 

Definition        When the blood-sugar levels falls below normal, brain function is affected.

 

Causes           ·      Body fails to produce sufficient amount of insulin (chemical produced by the pancreas which regulates sugar level in blood).

• Missed meals
• Excess exercise

 

Recognition    ·      RESPONSE:           Aggressive / confused / Rapid loss of consciousness

• AIRWAY: Nothing to help recognition
• BREATHING: Normal

 

• Rapid and strong pulse
• Weakness, faintness or hunger
• Pale, cold skin and sweating
• Possibility of seizures happening
• Palpitations and muscle tremors
• Warning medallion, bracelet, sweets, insulin syringe

 

Treatment       ·      Sit casualty down

• IF CASULTY IS CONSCIOUS: Give a sugary drink, which allows rapid absorption of sugar into blood
• IF CASUALTY IS UNCONSCIOUS: Do not give casualty anything to eat or drink.
• Perform primary survey and act accordingly. Place in recovery position if breathing normally.

 

Poisons

Definition        Also called a toxin – is a substance which, if taken into the body in sufficient quantity, may cause temporary or permanent damage.

Causes           Can be swallowed, inhaled, splashed into the eyes, absorbed through the skin or injected.

Treatment       ·      Keep casualty still

 

Route of entry in body	Poison	Possible effects / recognition	Treatment
Swallowed	Drugs & alcohol Cleaning products DIY and gardening products Plant poisons Bacterial (food) poisons Viral (food) poisons	Nausea and vomiting; Abdominal pain; seizures; irregular/fast/slow heartbeat; impaired consciousness; pain or burning sensation	Primary Survey Call 112 CPR if necessary
Absorbed through the skin	Cleaning products DIY and gardening products Industrial poisons Plant poisons	Pain; swelling; rash; redness; itching	Remove contaminated clothing Wash area for at least 10mins Call 112 CPR if necessary
Inhaled	Fumes from cleaning and DIY products Industrial poisons Fumes from fires	Difficulty in breathing; Hypoxia,; cyanosis;	Help casualty into fresh air Call 112 CPR if necessary
Splashed in the eye	Cleaning products DIY and gardening products Industrial poisons Plant poisons	Pain and watering of the eye; blurred vision	Irrigate the eye Call 112 CPR if necessary
Injected through the skin	Venom from stings/bites Drugs	Pain, redness, swelling at injection site, blurred vision, nausea; vomiting; difficulty breathing; seizures; impaired consciousness; anaphylactic shock.	For sting / venom: Remove sting if possible Call 112; CPR if necessary. For injected drugs: Call 112; CPR if necessary.

 

• DO NOT INDUCE VOMITING
• DO NOT GIVE CASUALTY ANYTHING TO DRINK except if the casualty’s lips are burnt by corrosive substances. In such a case give casualty frequent sips of cod milk or water while waiting for medical help to arrive.

 

 

Burns and scalds

 

Causes          

Type of Burn	Causes
Dry burn	Flames · Contact with hot objects such as domestic appliances or cigarettes · Friction, as in rope burns
Scald (moist burn)	Steam · Hot liquids, such as tea, coffee or hot fat
Electrical burn	Low voltage current, as used by domestic appliances · High voltage currents, as carried in mains overhead cables · lightning strikes
Cold injury	Frostbite · Contact with freezing metals · Contact with freezing vapours such as liquid oxygen or nitrogen
Chemical burn	Industrial chemicals, including inhaled fumes and corrosive gases · Domestic chemicals and agents, such as paint stripper, caustic soda, weed killers, bleach, oven cleaner, or any other strong acid or alkali
Radiation burn	Sunburn · Over-exposure to ultraviolet rays from a sunlamp · Exposure to a radioactive course, such as an X-Ray

 

Depth of a burn

Superficial burn      Involves only the outermost layer of the skin (epidermis). This type of burn usually heals well if first aid is given promptly and if blisters do not form. Sun burn is one example. Other causes include minor domestic incidents.

 

Partial-Thickness    Destroys the epidermis and are very painful. The skin becomes red and blistered. Blisters form over the skin due to fluids burn                                released from the damaged tissues. These burns usually heals well, but they can be serious if large areas of the body are affected. If they cover more than 20% of the body they may be fatal.

Full- Thickness        All layers of the skin are affected. There is generally damage to nerves and thus pain sensation is usually lost, which may

Burn                        mislead you and the casualty about the severity of the injury. Fat tissue, muscles and blood vessels may also be damaged. The skin may look waxy, pale and charred. These burns need urgent medical attention.

 

Extent of a burn

If the casualty is a child, call a doctor or take the child to hospital, however small the burn appear.

For other people seek medical attention for the following situations:

• All full-thickness burns
• All burns involving the face, hand, feet or genital area.
• All burns that extend right around and arm or leg
• All partial-thickness burns larger than 1% of the body surface
• All superficial burns larger than 5% of the body surface.
• Burns with a mixed pattern of varying depths.

 

If not sure about the severity of the burn, seek medical attention

Treatment       ·      Remove any dangers

• Lie casualty down
• Pour cool water over the burn/scald for at least 10 minutes (20mins for chemical burns), until pain subsides.
• CALL 112 for an ambulance
• Remove any constrictions (rings, watches, belts, shoes, or smouldering clothing before tissues begin to swell. Burnt clothing should be removed only if it is not sticking to the burn.
• Treat for shock.
• Cover the area with a sterile dressing (or plastic film / kitchen foil provided the first two turns are discarded) to protect from infection and secure with a bandage or                                                                 adhesive tape applied over the plastic and not the skin.
• Monitor the vital signs until help arrives.

 

DO NOT          Touch the burnt area

DO NOT          remove stocking clothing (unless it it contaminated with chemicals)

DO NOT          burst blisters

DO NOT          Apply lotions or creams

DO NOT          use fluffy materials

DO NOT          underestimate the seriousness

DO NOT          over-cool the casualty (particularly children and babies)

Stroke

Causes           When the blood supply to part of the brain is suddenly and seriously impaired by a blood cloth or ruptured blood vessel

 

Recognition    There may be:

Problems with specch and swallowing

If asked to show teeth, only one side of mouth will move or movement will be uneven.

Loss of power or movement in limbs

Sudden severe headache

Confused, emotional mental state that could be mistaken by drunkenness

Sudden or gradual loss of consciousness

 

Treatment       If conscious:     Reassure casualty

Lie casualty down with head and shoulder slightly raised and supported.

Incline head to the affected side

Loosen any tight clothing that might impair breathing

 

If unconscious DRAB and act accordingly

 

Electrical Shock

 

Low voltage current        •        Break the contact between the casualty and the electrical                                                                                 supply by switching off the current at the mains

• If socket or cable cannot be reached, stand on an insulating  material (books, wooden box…) and use a broom to push casualty’s                                                                            limb away from the source.
• When casualty is clear from source of electricity, perform DRAB and                                                         act accordingly.

 

DO NOT  touch the casualty as he may still be “live”

DO NOT use anything metallic to break the electrical contact

High-voltage current       •       Contact with high-voltage current is usually fatal. Anyone who survives will have severe burns. Usually the schock produces a muscular spasm  that may propel the casualty some distance away, causing injuries such as fractures.

• Power must be cut off before reaching the casualty and so you must call 112 first. Keep bystanders away from the incident area. High voltage electricity may jump up
• Casualty may be unconscious. Once it is safe to do so, conduct the primary survey (DRAB) and act accordingly